Childhood asthma and infection: virus-induced exacerbations as determinants and modifiers

Abstract

Respiratory infections have been implicated in the origin and exacerbation of asthma in a variety of ways; however, systemisation of this knowledge in a way helpful for disease management remains suboptimal.Several conceptual issues need to be taken into account: the fact that the effects of an infection may vary according to genetic background, the current immune status of the host, and parallel environmental stimuli, in addition to the particular infectious agent itself. Moreover, childhood is a very special period because of the continuous processes taking place, such as neural, immune and respiratory maturation.Epidemiological studies have convincingly demonstrated that the majority of asthma exacerbations, in both adults and children, follow viral upper respiratory tract infections. Asthma exacerbations are still often unresponsive to current asthma treatment, and new therapeutic approaches are required.This review presents current knowledge on the associations between infection and exacerbation of established asthma with respect to definitions, epidemiology, mechanisms and treatment.

Rhinovirus vaccination: the case in favour

“…The majority of upper respiratory tract infections and most uncomplicated cases of acute tracheobronchitis are due to respiratory viral infections [1]. Moreover, respiratory viruses play an important role as infective triggers of acute exacerbations of chronic respiratory diseases such as asthma [2][3][4][5] and chronic obstructive pulmonary disease (COPD) [6][7][8]. Human rhinoviruses (HRVs) were by far the most frequent respiratory viruses detected in most of the studies cited.…”

Vaccines for children and adults with chronic lung disease: efficacy against acute exacerbations

“…HRVs are the most common cause of ARIs, yet there are no approved anti-viral agents. They are also important infective triggers of acute exacerbations of chronic lung disease, including asthma [163][164][165] and COPD [24,166]. Hence vaccine prevention of HRV infection is an attractive option for disease management.…”

Respiratory Viral Infections in Exacerbation of Chronic Airway Inflammatory Diseases: Novel Mechanisms and Insights From the Upper Airway Epithelium

“…Treatment and management vary greatly in efficacy due to the complexity and heterogeneity of the disease. This is further complicated by the effect of episodic exacerbations of the disease, defined as worsening of disease symptoms including wheeze, cough, breathlessness and chest tightness (Xepapadaki and Papadopoulos, 2010). Such exacerbations are due to the effect of enhanced acute airway inflammation impacting upon and worsening the symptoms of the existing disease (Hashimoto et al, 2008;Viniol and Vogelmeier, 2018).…”

“…These agents elicit an immune response leading to infiltration of activated immune cells that further release inflammatory mediators that cause acute symptoms such as increased mucus production, cough, wheeze and shortness of breath. Among these agents, viral infection is one of the major drivers of asthma exacerbations accounting for up to 80-90% and 45-80% of exacerbations in children and adults respectively (Grissell et al, 2005;Xepapadaki and Papadopoulos, 2010;Jartti and Gern, 2017;Adeli et al, 2019). Viral involvement in COPD exacerbation is also equally high, having been detected in 30-80% of acute COPD exacerbations (Kherad et al, 2010;Jafarinejad et al, 2017;Stolz et al, 2019).…”